AU PAIR REGISTRATION FORM

Transcription

1 AU PAIR REGISTRATION FORM Basic Details: Name: Surname: Gender: Date of birth: Age: Physical address: Landline: Cell no: address: Religion: Marital status: Do you have children? Please provide details: Smoker: Y N Language/s spoken:

2 Are you taking any chronic medication? If yes, please provide details Have you ever been treated for a psychiatric condition? If yes, please provide details: Have you ever been treated for alcohol abuse? If yes, please provide details: Have you ever been treated for drug abuse? If yes, please provide details: Have you ever been admitted to a rehabilitation centre for treatment? If yes, please provide details: Do you have a police record? Vehicle: Licence: Y N Transport: Y N How long have you been driving for? Have you been in any motor vehicle accidents? Make of car: Year: Seat Belts: Y N

3 Education What year and which school did you matriculate at? Please provide details of further studies: How did you hear about Fab Au Pair Agency? Availability: Available from: Available to: Please select the following the days and times that you are available. Monday: am pm all day Tuesday: am pm all day Wednesday: am pm all day Thursday: am pm all day Friday: am pm all day

4 Summary of previous childcare experience: Reference One Family/Institution name: Period employed: Age of children: Contact Details: Duties/responsibilities: Reason for leaving: Reference Two Family/Institution name: Period employed: Age of children: Contact Details: Duties/responsibilities: Reason for leaving:

5 References: Please provide two valid references. Why would you like to be an au pair? Tell us about yourself: Have you completed any of the following If yes, please provide details: First Aid Life saving Childcare course

6 When you come for the interview, please bring with you: A copy of your CV Your completed registration form Letter/s of reference Certified copy of ID and copy of Driver s license Copies of certificates (matric, first-aid, other) A photograph of yourself R150 administration fee which is payable at the interview (This covers all agency administration on your behalf- phone calls, reference checks, family administration, interview costs, setting up of au pair profiles as well as family interviews.) Terms and Conditions 1. I confirm that all information given above is correct and truthful. 2. I consent to Fab Au Pair Agency to using the above information to find me a position as an au pair. 3. I consent to the above information being used by Fab Au Pair Agency as follows: 3.1 to create an electronic profile on the Google Drive database to archive the information; 3.2 to advertise my Google Drive profile (referred to in clause 3.1) on social media; 3.3 to use the information to conduct security / criminal record checks prior to commencement of employment with the host family; 3.4 to disclose the information to the host family in order for the said host family to consider my application for employment as an au pair, including but not limited to conducting security / criminal record checks; 4. I agree that the R administration fee is never refundable. 5. I agree that I will not enter into any communication nor will I commence employment with a family until such a time that all paperwork has been completed and Fab Au Pair Agency has given me permission to commence employment and make contact with such family. 6. I agree that I will not divulge my contact details to such family in my interview with them until such a time that Fab Au Pair Agency has given me permission to do so. 7. I agree to always give of my absolute best and to be a dedicated, responsible and conscientious au pair. Signature of au pair Date